Re: Having health insurance and getting denied for a pain script

[Guest guest]

--- lorial wrote:

>Hi I just needed to vent about my insurance company that i have. I currently

take oxycodone and methadone but i have been on the same dose for 5 yrs.

>I have gone to a new pain management Dr and he decided to put me on Oxycontin 3

times per day and use the others for breakthrough pain. Anyway the insurance

denied my script and now i will have to pay out of pocket which will probably

cost between 400 and 500 dollars per month.

Hi Lorial

Have you called your insurance company and asked them why they won't pay for it?

You might simply need to have a prior approval form filled out.

A prior approval often requires that your doctor tell them that other pain

medications are not giving you the relief you need. It is possible then that you

might have to drop one of your other pain medications.

There is also the possibility that they will not pay for Oxycontin because it's

so expensive.

You might ask your doctor to consider one of the long acting morphine

medications like MS Contin. It is much, much cheaper than Oxycontin.

Call your insurance company and see what one of their customer service

representatives says. Many times insurance companies are all about the right

paperwork being completed.

If you do chose to pay for Oxycontin out of pocket only buy a few, so you can

see if it really helps. Why spend that much money, only to find that it isn't

helpful.

Kaylene

Moderator

[Guest guest]

Lorial

  Hi  I would call the insurance company before spending the money on the new

script. It could be a matter of getting prior approval because of the type of

medication it is and that you are still taking. They may want to hear from your

doctor that you are not getting over medicated. I have trouble with my worker

compensation carrier not wanting to pay for my drugs sometime. Then I have to

call them and set them straight. A simple call could save you a lot of money.

Good luck

Toni

--- Lorial wrote:

>I am so frustrated with the system that i just want to scream. I'm thinking

should i threaten the insurance company with a lawsuit or just let it go and pay

for it myself. I'm on disability and that would be over half of what i get per

month. would like some imput please.

[Guest guest]

Lorial,

Many insurance companies have a formulary (list of medications)

that they will only pay for. Call your insurance company and ask for

their formulary or what pain medications that they will pay for.

My insurance formulary changes quarterly and they do not let you know, you have

to ask them or go to their website to see what medications

need brand name only authorization, prior approval, or need to take

forms.

I have found it good to know these things as afterwards is not a

good thing. My insurance did pay for my medication retro active though

when they got the letter from my doctor. Hope that helps.

Insurance companies do not like to pay for Oxycontin because of the

potential to be sold or abused. I know my Avinza is more expensive and

the insurance company pays for that. Hope you get it corrected.

Bennie

[Guest guest]

Lori,

Have you called your insurance company to speak with them about this situation?

I have had to do that before & I had to be pretty forceful to get the medication

I needed. During the phone call, you may have to ask to speak to the person's

supervisor about the need to get the medicaton approved. Sometimes, you may have

to file an appeal with the insurance company. Don't give up! Be your own

advocate.

Lori in Texas

Lori wrote:

>

> I have gone to a new pain management dr and he decided to put me on oxycontin

3 times per day and use the others for breakthru pain. Anyway the insurance

denied my script and now i will have to pay out of pocket which will probably

cost between 400 and 500 dollars per month.

>

[Guest guest]

--- " lori " wrote:

> I have gone to a new pain management dr and he decided to put me on oxycontin

3 times per day and use the others for breakthru pain. Anyway the insurance

denied my script and now i will have to pay out of pocket which will probably

cost between 400 and 500 dollars per month.

Lori -

It may be as simple to solve as having your doctor fill out the appeal paperwork

for the insurance. Let your doctor's office know they denied it, then call your

insurance, have them fax the forms to your doctor, and they will handle the

rest. Your doctor's office may be willing to call your insurance direct for you

so you don't have to even do that step - some do.

We all run into this repeatedly after being on meds for any period of time.

It's just part of the process. Don't get angry, and don't give up. Just get

them to file the proper paperwork.

My insurance annually tries to deny my asthma preventative medicine, claiming

that I have a " cheaper " alternative - that is, to go ahead and have the asthma

attacks and then use my albuterol rescue inhaler. That's nuts. My doctor just

faxes them a justification and they approve it for another year.

Cheryl in AZ

Moderator

[Guest guest]

Thank you Lori for responding. Yes I was about to give up but now i will file a

appeal. In the meantime i will try to get the funds needed to fill it which will

be between 300 and 500 dollars, can you believe it?

 

love and peace lorial

--- lori.renfroe wrote:

>Lorial,

>Have you called your insurance company to speak with them about this situation?

[Guest guest]

Thank you Cheryl you give me hope. I was so down and out thinking about what

these insurance companies get away with. My son told me to call the local news

station but i don't want to do that.

 

Love and peace Lorial

--- Cheryl in AZ wrote:

>Lori -

>My insurance annually tries to deny my asthma preventative medicine, claiming

that I have a " cheaper " alternative - that is, to go ahead and have the asthma

attacks and then use my albuterol rescue inhaler. That's nuts. My doctor just

faxes them a justification and they approve it for another year.

[Guest guest]

My insurance company also tried to block me from my inhalation med, until i had

to go to the hospital 2 day in a row for breathing treatments.

They decieded it was cheaper to give me the medicine. keep on top of it maybe

they will do the right thing. If you're like me Dont do without, go to the

Hospital.

--- Cheryl in AZ <professorcj@ yahoo.com> wrote:

>Lori -

>My insurance annually tries to deny my asthma preventative medicine, claiming

that I have a " cheaper " alternative - that is, to go ahead and have the asthma

attacks and then use my albuterol rescue inhaler. That's nuts. My doctor just

faxes them a justification and they approve it for another year.

[Guest guest]

go with methadone. 120 10 mgs cost round 30.00 a month, and work better

[Guest guest]

--- Lori Crotta wrote:

>

> Thank you Cheryl you give me hope. I was so down and out thinking about what

these insurance companies get away with.

Hi Lori -

It is absolutely maddening and frustrating that we have to go through this

process over and over again, isn't it? Some paperpusher at the insurance

company gets to decide what is the " right " treatment for me, like the doctor

isn't qualified. And it always seems to happen when we're at our most " down "

and just can't seem to find the energy to deal with it.

But don't ever forget that you have alternatives. Get your doctor's office on

your side as your advocate with the insurance and in the search for

alternatives. We just have to learn to work the system. You'll get better at

knowing where the loopholes are as you continue down the chronic pain path, sad

to say. I wish none of us ever had to figure this stuff out!

When I get so frustrated with my insurance, I have to keep telling myself that

at least I have insurance. Without it, I'd be bankrupt and in a lot more pain!

We have to consciously count our blessings and let the frustration go.

And, in your situation, as several other people have suggested, there are a LOT

of alternatives to Oxycontin that your insurance may be willing to pay for,

which will work just as well if not perhaps even better! And if they just won't

cover anything, there are much cheaper alternatives that won't drain your

pocketbook.

Hang in there!

Cheryl in AZ

Moderator

[Guest guest]

Thank you for responding and for the information. I already take methadone but i

didn't know it was that cheap. my son lost his health insurance so he pays out

of pocket for his two pain scripts so methadone would be a better option for

him. yes you are right methadone does work better and sure lasts longer than any

other med i have tried.

 

love and peace lorial

--- BUC F.@DARKSTAR wrote:

go with methadone. 120 10 mgs cost round 30.00 a month, and work better

[Guest guest]

> Cheryl in AZ wrote:

>

>Lori -

>

>My insurance annually tries to deny my asthma preventative

>medicine, claiming that I have a " cheaper " alternative - that

is, to go ahead and have the asthma attacks and then use my

albuterol rescue inhaler. That's nuts. My doctor just faxes them

a justification and they approve it for another year.

Cheryl,

I had to have a laparoscope surgery before I could have my

hysterectomy to " prove " I needed the hysterectomy even though an

ultrasound showed I had adnomyosis of my uterus and my uterus needed to be

removed.

So the insurance company spent over seven thousand dollars, I had to

go through pain, wait three more weeks, and then get the hysterectomy.

Sometimes, it just doesn't make sense what insurance companies insist upon.

There was an intern at my laparoscope and she couldn't believe that I was going

to have a laparoscope before hysterectomy and I said I wish they just could just

maybe cut an artery or something so they could do the hysterectomy then and we

both laughed but we couldn't.

I encourage anyone to keep petitioning for the right thing.

Bennie

[Guest guest]

Lorial wrote:

> Thank you Lori for responding. Yes I was about to give up but now i

> will file a appeal. In the meantime i will try to get the funds

> needed to fill it which will be between 300 and 500 dollars, can you

> believe it?

>

> love and peace lorial

>

Lorial,

I have a credit card just for situations such as this until I can

get a response from my insurance company. I have found that calling

yourself after your doctor has submitted an appeal and being super

nice to a representative will get them to complete your form quicker

as they just see a pile of paper and do not know you personally. This

has worked for me and it is hard to do when you feel really bad and I

think they should not do this. Good Luck. Bennie

[Guest guest]

> So the insurance company spent over seven thousand dollars, I had to

> go through pain, wait three more weeks, and then get the hysterectomy.

> Sometimes, it just doesn't make sense what insurance companies insist upon.

>

>Hey Everyone,

I apologize in advance because this is kind of on topic, but not quite. I really

just need to vent right now and will thank everyone in advance for listening to

me this afternoon.

The short version of things is my husband had carpal tunnel surgery done at the

beginning of the month. The company offers short term disability, which my

husband took advantage of. The neurosurgeon that performed the surgery has

released my husband to go back to work with no restrictions tomorrow (my husband

is a flat bed driver). After being given the run around as to what kind of

release the company will accept and being told numerous different things by

numerous different people, the company doctor is not comfortable with my husband

going back to work until 1 May so that his wrist may heal properly. The company

handling the short term disability is taking out the insurance payment to ensure

that we continue to have medical coverage while my husband recovers from his

surgery.

Tomorrow, I get to call the trucking company to find out why our insurance was

canceled on the 27th of this month if the insurance premiums were being taken

out of the disability check (and I have the paperwork showing that it was) and

when the insurance will be reinstated. I also get to see if the short term

disability will be continued because the company doctor is uncomfortable with my

husband returning to work so soon after his surgery.

My husband had a bad feeling about getting the surgery done while freight was

slow, but he couldn't put it off any longer than he already had. The trucking

company is having financial issues, just like everyone else is right now, so

they are looking to save money any way possible right now. My husband is nearing

the two year mark with the company, so that will increase his pay by a penny a

mile. He's also due the remainder of his sign on bonus, his quarterly safety

bonus and his vacation pay, which translates into a four figure paycheck because

everything is due on his anniversary date.

I found out about the insurance when I had to have a prescription filled this

afternoon. Two things I'm thankful for-the prescription was only $14 (without

insurance) and I'd gotten a refill on my meds at the end of February which will

get me through this mess while they figure out what is going on.

Hearing all of this has caused my pain levels to spike, so it looks like I am

going to take an extra Vicodin tonight and start tomorrow with the attitude that

I am not going to take no for an answer as far as the insurance being reinstated

goes.

Thank you for letting me vent because it helped.

Bobbie

>

[Guest guest]

--- " noreaster22 " wrote:

> I really just need to vent right now and will thank everyone in advance for

listening to me this afternoon.

> > Tomorrow, I get to call the trucking company to find out why our insurance

was canceled on the 27th of this month if the insurance premiums were being

taken out of the disability check

Hello Bobbie -

I'm so sorry you're having to go through all the stress of dealing with the

insurance and your husband's company. I know all too well how much stress like

that can spike your pain levels!

Just try to breathe deep and relax as much as possible, and we'll all keep our

finger crossed for you that it all works out.

Vent any time you need to!

Cheryl in AZ

Moderator

[Guest guest]

Hi Everyone,

I just wanted to let everyone know that my issue with the insurance company

(being told our insurance had been canceled) turned out to be a glitch in the

computer and we still have insurance, thankfully. Now that I look back on it,

the company that my husband works for seems to have this glitch about once or

twice a year concerning the insurance.

As for my husband's situation (having carpal tunnel surgery then being told by

the company that it's too soon to return to work even though he'd been released

by the neurosurgeon and having his short term disability canceled), the

neurosurgeon has faxed a note saying that my husband will be off work until 13

April and his short term disability will be reinstated to cover that time frame.

Now if we could just get the insurance company to issue the checks like they are

suppose to (they are currently a week behind as I type), we would be happy.

Thanks for the support.

Bobbie

[Guest guest]

--- Bobbie wrote:

>I just wanted to let everyone know that my issue with the insurance company

(being told our insurance had been canceled) turned out to be a glitch in the

computer and we still have insurance, thankfully.

>Now if we could just get the insurance company to issue the checks like they

are suppose to (they are currently a week behind as I type), we would be happy.

Hi Bobbie

What a relief for you to know that you still have medical insurance. Call them

and bug them about sending your checks.

To quote a very old saying " the squeaky wheel gets the grease. " You don't have

to be nasty, just persistent.

Kaylene

[Guest guest]

---Kaylene wrote:

> To quote a very old saying " the squeaky wheel gets the grease. " You >don't

have to be nasty, just persistent.

Kaylene,

If only it worked that way. The claim is in my husband's name, which means the

company can't discuss anything with me, and he has a wait and see approach to

everything while I am more " proactive " -after dealing with workman's comp for two

years, you learn to speak up about certain things. He calls to find out about

things only to placate me some days. The workman's comp company was quicker

getting a check out after going through a devastating hurricane than this

company is when there is no natural disaster.

It's really a vicious circle when it comes down to getting the insurance company

to send out the checks on time. My husband has called the company handling the

short term disability claim, they refer us back to the company my husband works

for who says that their hands are tied. Right now, the company is two checks

behind and if I didn't think that it would screw things up even more, I'd let

someone know what was going on.

I'm looking on the bright side though-my husband's had the carpal tunnel issue

taken care of, we're getting to spend time together that we wouldn't normally

have and two or three nights a week, I don't have to worry about fixing supper

or doing dishes. Some days, you can't ask for more than that, right?

[Guest guest]

May I ask - since when does an insurance company consider carpal tunnel elective

surgery? I would most definitely fight with the short term disability company

on this one.

Deb

[Guest guest]

>

> May I ask - since when does an insurance company consider carpal tunnel

elective surgery? I would most definitely fight with the short term disability

company on this one.

> Deb

>

Hi Deb,

Ever since my husband started talking about having the surgery done, the company

that he works for and the insurance company have referred to it as elective

surgery. I am not sure, but it may have something to do with the fact that the

carpal tunnel issue was a pre-existing condition (he had surgery done on the

right wrist at 17).

Bobbie

[Guest guest]

Bobbie,

What kind of work does your husband do? Could the CTS be from his job? I

would be writing the letter to the insurance company...if the carpal tunnel

problems were pre existing as long as the policy has been in place longer

then a year it shouldn't be a problem.....pregnancy is an elective situation

and STD pays for that....

Deb RN

-----Original Message-----

Ever since my husband started talking about having the surgery done, the

company that he works for and the insurance company have referred to it as

elective surgery. I am not sure, but it may have something to do with the

fact that the carpal tunnel issue was a pre-existing condition (he had

surgery done on the right wrist at 17).

Bobbie

[Guest guest]

>

> If only it worked that way. The claim is in my husband's name, which means the

company can't discuss anything with me, and he has a wait and see approach to

everything while I am more " proactive "

My husband and I ran into that issue as well. He's busy working 11 hours a day

because I can't work at all, so I'm the one with the time (and inclination) to

call and solve these stupid problems that come up.

We solved the issue by him giving the doctors and insurance permission to

discuss things with me. Now I call and, if they take issue, can look in their

files and see that I'm " cleared " to talk about his stuff.

Also, sometimes WHAT info you're looking for can be key. Yesterday, I had to

call the tax prep office that did my mother in law's taxes. I prefaced by saying

that, while I was about to ask a question, I didn't need any personal or

protected information about their client. (It was a simple question about what

needed to be mailed, and where.) If the info or input you want isn't personal,

there's no clause stopping them from helping you, and it has saved my hubby many

times from having to race home from work to sit on hold!

(Oregon)

[Guest guest]

Should this situation ever arise again, we will definitely go that route. I

guess everyone figures that since my husband is home recuperating that he can

take care of things, but that does not mean that he is always here to take a

phone call at that time.

Bobbie

> >

> > If only it worked that way. The claim is in my husband's name, which means

the company can't discuss anything with me, and he has a wait and see approach

to everything while I am more " proactive "

>

>We solved the issue by him giving the doctors and insurance permission to

discuss things with me. Now I call and, if they take issue, can look in their

files and see that I'm " cleared " to talk about his stuff.

>

> (Oregon)

>